Skills

Eating Disorders are brilliant at tricking people. Parents and carers can often find themselves falling into traps.

“Accommodation” is something that can happen to anyone. It’s when a person (parent, carer, friend or professional) “accommodates” the eating disorder in some way. It may be changing a normal way of life in order to inadvertently support odd eating disorder demands. It can often come from a good place such as buying a certain brand of food because you know it’s easier for the person – therefore, “accommodating” the eating disorder for that person.

The traps below are very common and were all described by parents involved in developing this website. These parents and carers stated that they wish they had known these at the start of their loved one’s treatment.

Shopping for the Eating Disorder
You might find yourself buying particular types of foods or specific brands. You might do this because it’s the only thing your loved one says they will eat or if you have given them something else they have become very distressed. This food will be “safe” – pre-approved by the eating disorder.
This is a trap. This is how the eating disorder controls you and your loved one. Food is not scary and by shopping for the eating disorder, it is inadvertently reinforcing the idea that it is. Also, not supporting your loved one in learning that they can experience the distress of trying something scary and develop healthy coping strategies to manage this.

Small portions
You may find yourself giving your loved one a portion that is smaller than they would have had before the eating disorder, or smaller than the rest of the family has. You might feel it’s not enough but better than nothing and “at least they are eating something”. This can reinforce anorexic thinking – “they are giving me less because that’s all I need”, “that’s a normal portion”, etc. If you know that it is not enough, give them more. You can do this.

Safe foods
Like shopping for the eating disorder, this is another way it stays in control. Safe foods may be things like vegetables or a certain brand of cereal or bread. It could also involve eating in a restrictive way which was not present prior to the eating disorder. For example, a “trick” of the eating disorder is to cut back on certain food groups, such as becoming vegan or the eating disorder convincing someone that they have a food intolerance.

Activity
Eating disorders can cause a strong desire to move around or be active that can be hard to resist. It may be as little as standing on the bus instead of sitting. An eating disorder will look for any excuse to move. This is to burn energy (calories). Sometimes an eating disorder can trick someone into extra movements like offering to take the bin out. A person may feel compelled to do this for various reasons: the eating disorder is telling them they need to move for lots of horrible reasons, like they are too “fat”, or it may be telling them they do not deserve to rest. For younger children, it may feel more like an overwhelming agitation to move rather than the “need to burn energy”. The trap is allowing or accepting this extra movement or exercise, particularly during weight restoration stage. Things like; allowing them to stand when it would be normal to sit, or not challenging the fact they are staying up later and later (to be more active). Activity and exercise is often viewed as “healthy” within our society however, when the drive behind this is an eating disorder, your loved one is not in control. You may need to support your loved one not to engage in this extra movement or exercise; recognise it as the eating disorder and develop strategies to tolerate or manage these urges.

Not mentioning that thing you pretended you didn’t see
Something dropping onto the floor, the hurried rush to the bed and flushed face when entering a room (exercise?!), unblocking the toilet or refilling the cupboards before the rest of the family notice food is missing.
The eating disorder is getting more powerful while the young person feels like no one is noticing it.

BMI – Body Mass Index: BMI is a value that comes from the weight and height of a person. It is an attempt to measure how much mass (fat, muscle, bone) is in a person which then determines if they are underweight, overweight, obese or normal weight based on the number. It is not widely used in young people under 18.

YPU/IPU – Young people’s unit or inpatient unit.

CAMHS – Child and Adolescent Mental Health Services

CBT – Cognitive Behavioural Therapy / Eating Disorder Focused Cognitive Behavioural Therapy: Structured treatment which a set amount of session focusing on the way a person processes thoughts and feelings. It aims to support a person to deal with overwhelming feelings and problems by breaking down into small parts and helps stop a person getting stuck in a “negative thinking” cycle.

CBT-ED – Cognitive Behavioural Therapy eating disorder : Structured treatment specially for eating disorders which a set amount of session focusing on the way a person processes thoughts and feelings with the focused on eating disorder behaviours. It aims to support a person to deal with overwhelming feelings and problems by breaking down into small parts and helps stop a person getting stuck in a “negative thinking” cycle.

FBT – Family Based Treatment: a structured treatment approach involving the whole family. It is one of the recommended treatments for anorexia and bulimia. This is the recommended first choice of treatment for children and adolescents.

IPT – Interpersonal Therapy: This approach focuses on a person’s relationships with other people and the impact this has on their eating pattern.

MANTRA – Maudsley Anorexia Nervosa Treatment for Adults: a treatment for adults with anorexia. The treatment involves a person working through a workbook with a practitioner with a focus on motivation, separating anorexia from identity and involved family member /carers to understand treating disorder and support the person to change the eating disorder behaviour. This is a recommended treatment for adults with anorexia

Binge eating – To eat a high amount of food in one.

Maudsley – “Maudsley” may refer to the Maudlsey Hospital in South London. The hospital is the largest mental health training institute in the UK. Many eating disorder specialists are attached to the hospital.
The “Maudsley Approach” is Family Based Treatment.
The “New Maudlsey Approach” – is a collaborative carer approach developed by Janet Treasure and Colleagues.

The Matrix – Is a guide aimed at psychologists in Scotland that supports them to deliver evidence based psychological therapies.

Purging – this is something that is often done after a binge. A person can “purge” themselves through: self-induced vomiting, misuse of laxatives, diuretics, or enemas.

Recovery – a clinician may talk about your loved one being in recovery –they are aiming for the young person to maintain a normal weight range with minimal eating disorder thoughts and behaviours . Recovery to you and your loved one may mean more than just this.

SSCM – Specialist Supportive Clinical Management: a treatment for adults to assess identify and review key issues and problems. This is a recommended treatment for adults with eating disorders.

W4h – Weight for Height; this is a measure used by clinicians in child and adolescent mental health services. It works out more accurately what a person’s expected weight/weight range should be. This is a measure only used in young people under the age of 18.